By the time Boateng Wiafe sees them, many patients can barely see him - they are already going blind.
Serving more than one million patients and performing 2,000 eye surgeries a year, Dr. Wiafe is probably Africa's busiest ophthalmologist, treating people who are nearly blind from infection and degenerative disease. Some people don't know there's help as their world goes dark; others fear treatment.
"They cannot imagine that the eye can be worked upon while it's still in the socket," said Dr. Wiafe, regional African director for Operation Eyesight Universal, a Calgary-based development organization. "They think that the eye is plucked out, put in an open place, worked upon and put back."
Others believe blindness is just part of aging, something they've witnessed as they watched their elders lose vision. Superstition, too, is a fact of life in Africa. "They thought they were blind because someone bewitched them," Dr. Wiafe said.
He is trying to change those myths and misconceptions. Through Operation Eyesight Universal, which has been working in some of the globe's most impoverished regions to repair damaged eyes, treat infections and teach people how to avoid eye diseases altogether, Dr. Wiafe is about to launch an awareness campaign in Ghana, where he is from.
But attempts to raise the profile of preventable blindness - in the same way that HIV/AIDS and malaria have captured the attention of African leaders and the world - have not been easy.
"Eye surgery is the least of their worries," Dr. Wiafe said during a visit to the organization's head office. "It's not high on the priorities because it doesn't kill."
At least not right away. Blindness does cut life expectancy in poor regions by five years; it makes it tough for children to survive into adulthood, preventing them from going to school and slashing a family's income.
In the early 1960s, Canadian missionary doctor Ben Gullison was working in India when he noticed an inordinate number of cataracts, a problem characterized by clouding of the lens of the eye. He converted a hospital into a vision-care centre, but when the money ran out, Dr. Gullison returned to Canada to seek funds. A Baptist church group in Calgary rallied around his cause and raised so much money the program expanded.
In 1963, Operation Eyesight was established. It is still active in India, but has expanded to Africa, with a presence in Ghana, Kenya, Rwanda and Zambia. By the organization's estimates, it has since helped 35 million people, the bulk with treatment, and about 2.2 million through eye surgeries.
With an annual budget of between $6-million and $10-million, depending on the level of facility construction and well digging under way at any given time, Operation Eyesight also spearheads training programs, medication distribution and surgical procedures.
"I don't think Canadians have any idea how appalling the conditions of the hospitals are in Africa. It defies belief," said Pat Ferguson, president and chief executive officer of Operation Eyesight. "If you don't have good facilities and good equipment, you can't have good outcomes and you can't deal with blindness."
For example, the organization is trying to get control of the incidence of trachoma, an infectious eye disease common where there is poor sanitation and a lack of clean water. Without antibiotics, the infection can result in trichiasis, a condition that causes the eyelids to turn inward and the eyelashes to scratch the corneas, which leads to blindness. Dr. Wiafe shows off a set of crude metal tweezers that people afflicted with trichiasis use to pluck out their eyelashes as a home remedy.
Digging wells for fresh water and teaching proper hygiene can break the cycle of infection and blindness, he explained. And on a continent where there is one ophthalmologist for every one to two million people, preventing the disease is easier than diagnosing and treating it, he said.
Despite the obstacles, there are signs of progress.
Pharmaceutical giant Pfizer International has donated more than 145 million treatments of the antibiotic Zithromax for use in 18 countries to tackle trachoma. A pilot program in Zambia has cut disease prevalence from 50 per cent to 5 per cent. A decade ago, Ghana made it national policy to eradicate trachoma by 2010; it's on its way, as the rate of the disease has dropped below 3 per cent. In some places where new wells have been drilled, school enrolment has jumped 300 per cent.
"Instead of every year just trying to treat [eye disease]" Ms. Ferguson said, "we're going to the root causes of it."